PubMed · 10252156
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R L Nalbandian. 1981-08-11. Let's program lab tests.. https://pubmed.ncbi.nlm.nih.gov/10252156/
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The first part of this review discussed the facilities that are needed to provide a competent diagnostic virology service at the turn of the century. Just as important is to consider who will run it. Hitherto, there have been specialist virologists in most countries. Their roles have evolved with time, developing and running a variety of diagnostic tests, often to answer local needs and their own curiosity, and frequently linked to their research projects. Recently, the advent of an increasingly long list of commercial tests has raised the real possibility of introducing standardized centrally validated testing methods, and using them to bring laboratories up to a similarly uniform level. Unfortunately, they have also had the effect of seeming to make specialist virologists unnecessary, except in a few central reference laboratories. As a consequence, and because of increasing pressure on health service resources, vacated senior virology posts have remained unfilled and this now threatens the career structure of those who want to become, and continue as, virologists. This review explores these issues and offers a possible solution.
We have investigated the reliability of communication of uncertainty in radiological reports. The 18 most commonly used verbal expressions of probability were identified from a series of radiological reports. 11 clinicians (three radiologists, three rheumatologists and five orthopaedic surgeons) recorded the probability that they ascribed to each of the 18 expressions using visual analogue scales. Each subject was re-tested on four occasions at least 1 week apart. The results were analysed to assess reproducibility within and between individuals. We found considerable variation in the probabilities assigned to many commonly used expressions between subjects, and between repeated testing of the same subject. Some expressions were rated much more consistently than others. "Absent", "excludes", "unlikely", "probable", "certain" and "definite" were the most consistently rated expressions. We have identified a potential source of misunderstanding in radiological reports owing to differences in interpretation of expressions used by radiologists and referring clinicians.
The Annual Reports of the Mount Sinai Hospital from the 1850s, and the Mount Sinai Hospital Reports for 1897-1906, make it possible to trace the discharges of gastroenterological inpatients, and (for a few years) of outpatients. Fully computerized diagnostic data have only been available since 1986. In the 19th century, about 20% of the outpatients had digestive disorders, the commonest of which were gastralgia/gastritis/dyspepsia, gastroenteritis, oropharyngeal complaints and constipation. A similar proportion of inpatients had digestive diagnoses, but the four disorders listed above decreased markedly in the second half of the 19th century, so that by the turn of the century the commonest diseases were typhlitis (appendicitis), hemorrhoids and other anal problems. By the 1990s, digestive diseases accounted for only 5% of total admissions, hepatobiliary diagnoses being the commonest group. Some cancers such as gastric and esophageal showed little change, while colorectal increased markedly. Some newly recognized diseases, such as peptic ulcer, waxed and then waned, while colitis and regional enteritis came and have continued to increase. Other new diagnoses, such as autointoxication and visceroptosis, flashed into prominence and then disappeared totally, presumably because they were nondiseases.